Wednesday, October 10, 2012

Gregory B. Saathoff M.D. is the latest mental health professional to weigh in on the Manssor Arbabsiar case. Marcy Wheeler at Emptywheel has been dissecting aspects of Saathoff's narrative of events surrounding Arbabsiar's interrogation and confession (see here, here, and here).

I want to look more closely at the claims Saathoff makes in an October 3 "Forensic Psychiatric Evaluation" on Arbabsiar's mental status, symptoms and diagnosis. The evaluation was dated the same day as a government memorandum arguing against a defense motion to dismiss or suppress evidence drawn from Arbabsiar's interrogation. The reason for such dismissal or suppression? The defense presented expert opinion that Arbabsiar had been in a manic episode during the period of his interrogation, having a previously undiagnosed case of Bipolar Disorder. As a result, he was not in his right mind when he waived presentment (presentation before a judicial official) and his Miranda rights.

For those who have forgotten, Arbabsiar is Iranian-born, but a U.S. naturalized citizen, a Texas used car salesman with a cousin in the Iranian Quds force. According to U.S. prosecutors, in 2011, Arbabsiar contacted a confidential DEA informant in Mexico, and, believing he was talking to someone in a Mexican drug cartel, arranged the assassination of Saudi ambassador Adel al-Jubeir. But the assassination and other alleged terrorist plots, of course, never took place, and Arbabsiar was detained in Mexico, flown to the U.S. and interrogated by the FBI at (it turns out) an undisclosed military base from September 29 to October 10, 2011.

Here's Saathoff quoting FBI Special Agent Shalabi about what the latter called Arbabsiar's "erratic" behavior during his "confession" in the early morning hours of October 3:

FBI SA Shalabi recalled in a September 7, 2012 interview that after having observed Mr. Arbabsiar sleeping soundly, Mr. Arbabsiar awakened at 3 am and expressed concerns about jail. “The first thing out of his mouth was “What is jail like in the United States? How harsh are the conditions? What should I expect?” After going into the bathroom [where elsewhere we learn he "washed his shirt in the bathroom sink" - JK], Mr. Arbabsiar came back out into the living area, and FBI SA Shalabi recalled Mr. Arbabsiar’s statements and behavior:

“You know what I did?” And I said “no”. Then on his own accord, without me asking, (I decided to keep my mouth shut) he told me he was in big trouble. Had gotten involved in big politics. Wife had a lot of financial demands. Son’s pregnant girlfriend added more to the stress. So he told me that he decided to go to Iran to solicit more help for [his] family… He said that his cousin was a “big general”, [who] was “senior” with decision-making powers. [He was] Approached by cousin to then give money to kill the Saudi Ambassador. As he was telling me this, he reflected back on the whole situation. As he told me the story, [as] he said that, he looked upset and [said that he] had been used by his cousin. Then he went back to smoking [elsewhere Arbabsiar is described as smoking four packs a day - JK], tossed and turned, and then fell asleep.

For the U.S. it was a propaganda coup, for it claimed that someone in the Iranian government was planning or instigating a terrorist attack in the U.S. against a foreign diplomat. The hawks in the U.S. government squawked loudly and long.

No one ever seems to notice that the only foreign diplomat ever actually assassinated in the U.S. was former Chilean ambassador to the U.S., Orlando Letelier, murdered in Washington D.C. in 1973 by order of the government of Augusto Pinochet. The hit man was Michael Townley, an agent for Chile's intelligence directorate (DINA) who also worked for the CIA. In 2000, it was revealed that the mastermind of the terrorist attack, which also killed Letelier's assistant, Ronnie Moffett, was Chilean intelligence chief Manuel Contreras, and he, too, was a paid asset of the CIA.

In the case against Arbabsiar, the evidence seems sketchy. Wheeler points out that Saathoff's report explains the DEA informant Arbabsiar is supposed to have contacted "had a younger sister with whom he had a sexual relationship in 1992, while he was married to his third wife"! What a coincidence, one might say.

But particularly damaging to the government are the questions surrounding the veracity of his confession, which was attacked by top mental health experts brought in by the defense, who stated Arbabsiar, who had waived his rights within hours of capture (while possibly jonesing terribly for a cigarette), suffered from bipolar disorder and was not able to make a reasoned decision about his rights or actions.

Bipolar Disorder with "Impaired Cognitive Functioning"

The psychological reports by the defense were pretty damning. Psychologist Joel Morgan, whose credentials include membership on the Council of the American Psychological Association (APA), where he has represented Division 40, the Division of Clinical Neuropsychology for the past six years, conducted what appears to be a thorough examination, with a full battery of cognitive, neuropsychological, clinical and personality tests.

Next, the defense got the doctor who was the editor for the bible of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), Dr. Michael First, to add his opinion that upon examination of Arbabsiar, interviews with family, and review of clinical material the former Corpus Christi used car dealer had bipolar disorder and "impaired cognitive functioning."

"Because I believe that Mr. Arbabsiar was suffering from episodes of mania while he was being questioned by the FBI," Dr. First stated in his report dated July 13, 2012, "there are serious questions as to whether any decisions made by him during this period were made rationally, with a full understanding of the consequences. Indeed, it is likely that his decisions were influenced, at least in part, by his mental illness."

A person with bipolar disorder, Dr. First explained, has difficulty "comprehending the circumstances surrounding a particular decision or appreciating the consequences of that decision. Individuals with bipolar disorder who are in a manic state frequently display feelings of invincibility and grandiosity. These feelings may cause them to enter into agreements that they would not otherwise enter into."

This must have hit government prosecutors and the FBI like a ton of bricks. The United States Attorney’s Office for the Southern District of New York sprang into action. They contacted long-time government psychiatric "expert" Gregory Saathoff, who began interviewing Arbabsiar as early as August 3. Saathoff would meet with the prisoner another five times over the next six weeks.

A Member of Obama's Exclusive Interrogation Team Suddenly Appears

The government turned to another mental health expert as well. According to a New York Times report, on August 15 government attorneys handed Arbabsiar's defense team "a dense 21-page report that appeared to be from an unidentified doctor or a psychologist."

The psychologist turned out to be Dr. Susan Brandon, who was identified in Saathoff's report as a "research psychologist." According to Saathoff, Brandon "was present during all of the post-arrest questioning of Mr. Arbabsiar." Apparently she viewed Arbabsiar via closed-circuit, where she "closely monitored and documented Mr. Arbabsiar’s behaviors."

Susan Brandon credentials are not identified in Saathoff's report, but elsewhere she is publicly known as the "Chief of Research for the High Value Detainee Interrogation Group, an interagency group formed by [President Obama's] Executive Order 13491 (Ensuring Lawful Interrogations), via a detail to FBI from DoD." She is someone I've had reason to look at before, not least because of her involvement in organizing a 2003 CIA/Rand Corporation/American Psychological Association meeting that discussed abuse of detainees, including possibly use of drugs, to detect deception.

So what was the administration's top interrogation researcher doing at Arbabsiar's interrogation? And if she was doing research, was Arbabsiar so informed? And whether he was or not, what in her role as researcher later led Brandon to file a report with the court? These are all important questions and will be taken up in a separate article to come. For now we will have to bear with the fact that Brandon's report has been withheld from public view, the subject of a court protective order.

Saathoff's Bias

Saathoff had been tagged in late 2009 by U.S. District Court for D.C. Judge Royce C. Lamberth to write a postmortem psych eval on purported anthrax terrorist Bruce Ivins. (I looked critically at Saathoff's work in that case here.) According to the L.A. Times, Saathoff, who headed up Lamberth's ersatz Expert Behavioral Analysis Panel, "served as an FBI consultant during the anthrax investigation," raising basic conflict-of-interest questions. It was no surprise that Saathoff and his partners found Ivins to be as mentally disturbed as the FBI portrayed him. (A National Research Council report last year seriously questioned the FBI's evidence in the Ivins' case.)

Saathoff has also served as psychiatric expert in the trials of Omar Ahmed Abu Ali, Dr. Aafia Siddiqui, and former Guantanamo detainee Ahmed Khalfan Ghailani. But in the Arbabsiar case, it is Saathoff's connections to the FBI that are most germane here, as he bases a great deal of his report's conclusions on interviews with FBI interrogators and guards.

To his credit, Saathoff is not hiding his credentials here. "Since 1996 I have served as the Conflict Resolution Specialist for the Critical Incident Response Group (CIRG) of the Federal Bureau of Investigation," he writes. "In this role, I have provided regular consultation to the CIRG’s Crisis Negotiation Unit, the National Center for the Analysis of Violent Crime, and the [FBI's] Behavioral Analysis Unit that specifically deals with terrorism-related crimes. I teach the psychopathology lectures for senior profilers who have been appointed to the Behavioral Analysis Units."

Now it should be evident that a psychological or psychiatric or medical examination of a prisoner should be objective and not biased. Indeed, Dr. Saathoff goes to some lengths to describe how "objective" he strives to be, and how "objective" his evaluation is. But his explanations have little to do with the practice of typical forensic evaluation.

In his report, Dr. Saathoff never uses an actual "objective" source of evaluation, despite his protestations otherwise. He relies purely on the subjective report of Arbabsiar, of testimony from FBI agents (with whom it must be difficult not to identify after working for the Agency for so many years), from Metropolitan Correctional Center (MCC) medical, mental health, and security personnel, and from -- Susan Brandon, the government's top researcher in interrogation.

In a moment of unintended hilarity, Saathoff quotes Brandon as telling him, "I haven’t seen many interrogations." In fact, there is nothing in her expertise or history that would qualify her to make a forensic examination or diagnose a mental disease. She is a research psychologist, not a clinical or forensic psychologist, but of course Saathoff never mentions how inappropriate it is to get advice from her.

Besides the lack of recognized and validated psychological instruments, which would compare Arbabsiar to normative populations -- Dr. Morgan used a number of these, for instance -- Saathoff apparently used a non-structured interview technique to assess his subject's mental condition. But most forensic psychologists know that especially lacking any other normed or validated psychometric form of evaluation a structured or semi-structured interview format should have been utilized.

“Assessment Tools for Adult Bipolar Disorder”

In a special issue on Bipolar Disorder in the June 2009 issue of the peer-reviewed journal, Clinical Psychology: Science and Practice, a literature review on the state of assessment of bipolar disorder states, "The diagnosis of bipolar disorder is based on a review of symptoms and potential medical explanations for those symptoms, as there is no biological marker for the disorder. In clinical practice, symptoms are frequently reviewed in an unstructured manner. It should be noted, though, that when practitioners do not use structured diagnostic tools, as many as half of comorbid conditions go undetected.... Due to informal or poor screening, the average time between onset of symptoms and formal diagnosis is more than seven years."

Nevertheless, Saathoff says in the report, "it should be noted that Mr. Arbabsiar has never been clinically diagnosed or received treatment for bipolar disorder or any mood disorder," as if evidence of a previously lacking diagnosis clearly indicates the falsity of Morgan and First's diagnosis. Saathoff makes this point over and over in the report. At the same time, he never once refers to any evidence that might contradict his conclusion. He never refers at all to psychological tests conducted by Dr. Morgan, including the Wechsler Adult Intelligence Scale, Fourth Ed., the MMPI-2, the Trailmaking Tests A & B, the Wechsler Memory Scale, and the Test of Memory and Malingering, among others -- all widely used and respected tests.

The authors of the Clinical Psychology article, "Assessment Tools for Adult Bipolar Disorder," clearly state, "The most reliable and valid way to obtain a diagnosis of bipolar disorder is through a structured interview with a trained clinician." But Saathoff never alludes to this.

Nor, to be fair, do either Morgan or First, even when First notes he was the "lead author" of one of the most popular structured interviews in psychology, and one the Clinical Psychology authors particularly recommend for diagnosis of adult bipolar disorder, the Structured Clinical Interview for DSM-IV Axis I Disorders, or SCID. (Another well-regarded structured instrument is the Schedule for Affective Disorders and Schizophrenia, or SADS.) Whether First used his own interview protocol, I don't know. He didn't say he did.

Saathoff gives credence to a diagnosis of Generalized Anxiety Disorder (GAD) given to Arbabsiar by a MCC doctor. He uses the fact Arbabsiar was diagnosed with anxiety and medicated for it. Yet it is incredibly naive, from a psychiatric viewpoint, not to recognize the possible existence of co-morbid conditions in a patient, and perhaps even more so in someone with bipolar disorder.

"Patients with BPD [bipolar disorder] are at higher risk for many other anxiety subtypes, including generalized anxiety disorder, simple phobia, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder," a 2009 article in Psychiatric Times explains. But Saathoff never even mentions or rules out the possibility of co-morbidity. For government expert Saathoff, GAD and Bipolar Disorder are apparently mutually exclusive diagnoses.

In the end, it is the preponderance of psychiatric evidence, such as the cognitive impairment documented by Dr. Morgan, and other data, such as third-party interviews with family members and assorted personnel (and yes, with a critical eye, that could include FBI agents) that together with one's own clinical experience in talking with a test subject produces the diagnosis, which can be termed a matter of clinical art and scientific discipline all in one.

When you add together Dr. Saathoff's FBI and government bias, his strange reliance upon a government researcher present, and the points on method and case conceptualization noted above, I think one must conclude his report cannot reasonably refute the conclusions of the defense experts.

In a follow-up article, I'll examine in more detail the evidence Dr. Saathoff gives for his conclusion that Arbabsiar did not have bipolar illness. While I am in no position to state what Arbabsiar's mental condition was during his interrogation, despite my own experience as a forensic evaluator and psychological clinician, I believe I can provide critical commentary on the data Saathoff presents, data which we will see appear to undermine his conclusion.

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I am a psychologist, living in Northern California. Over the years I have written about torture, national security, civil rights and other topics. Most of my stories, including major investigatory pieces, some co-written with Jason Leopold, have been published at Firedoglake, Truthout, and The Public Record.
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